Wednesday, February 27, 2013

Mrs. Poppy: "Hi, I need to pick up my Percocet prescription for the month."

Annie: "Hang on, let me check... Actually, we have your chart flagged. We discovered earlier this week that you're getting Percocet from 5 different doctors, and having them filled at 5 different pharmacies."

Mrs. Poppy: "Well, I can explain this..."

Annie: "Dr. Grumpy has it specifically noted not to refill your narcotics."

Mrs. Poppy: "Okay, the truth is that you're right. I am getting refills from multiple doctors. But I'm not actually taking it! I just store it. You know, in case there's ever a shortage. I keep it all in a shoe box in my closet. But I swear I'm not taking any. So can't you refill them? Because I'm really not using it at all?"

39 comments:

Anonymous
said...

Hey, that's not fair. My chemo drug has been in short supply all around the country for the past two years now, and I don't get to store extras in a shoebox. Why do narco users get special treatment????

Once had someone come in to the ER with a small pebble taped to his back. Was hoping the radiograph showed it to be a kidney stone because he knew they got meds. Sadly, the CT scan that was ordered kinda threw him for a... shall we say, "loop". He left before he could be taken to radiology...

I don't understand why people like Percocet so much. I've taken it. It does work well for pain, I'll give it that, but it made my ears ring and made me really itchy. I still have most of my script left, I should probably take it to back to the pharmacy so they can safely get rid of it for me...it probably wouldn't be too environmentally friendly to flush it.

don't take it back to your pharmacy, they will not dispose of it for you. your state's pollution control agency should have info on it's website on how to dispose of medications. some counties have drug disposal days, as well.

How did the docs and pharmacists figure out what was going on? How do we know that it is only 5 docs and 5 RXers?? What raised the red flag? How how many others are getting away with it?

I think (but stand to be corrected) that one of the benefits of centralized administration of health care in Canada is that everybody's prescriptions are in one database, so it would take a lot of effort to run that scam here.

Next year in BC we are getting new, very difficult to hack, medical ID cards / driver's licenses. The civil liberties voices are upset, but the new system will to make this type of con harder still.

Sadly, many doctors, when told their patients are seeing multiple doctors and using different pharmacies, just tell us to go ahead and fill the rx. They say they will "talk" to the patient at their next visit.

As someone that works in a pharmacy, I can tell you for sure that you can not take a controled substance in for disposal. You can however call the non emergency number for poision control in your area and they will advise you on how to dispose of it properly.

Everybody's prescriptions in Canada are NOT in one database. Even within a chain of he same stores, one store still has to phone the other to fax over a request. Maybe BC is different, but I highly doubt that.

What we DO have is a centralize system for narcotics and such. If you ever request pseudophedrine from a pharmacy, they will take down your information. And opiate prescriptions are written on a triplicate prescription pad, one part of which will go to some kind of government centre.

I can only assume that such medications in the States are also written in triplicate. When said government agency receives eight copies of the same request, someone eventually will flag it and - I assume - let pharmacies know.

What I'm saying is that it's not centralized. And even when centralized, things get missed. It's tougher with triplicate prescriptions though.

Yes, you can take old old prescription in for disposal. Click on the link I provided. You take it in and get the envelop, which cost $3.99. Put the meds in and send it away, or the pharmacy will do it for you. I've done it at a few different pharmacies. They have signs saying they do it, they advertise on the radio and tv that they do it, and I have seen ads in the newspaper saying they do it. Trust me, they do it. Maybe not in your state, but they do in mine.

Ronstew: In reference to how it is found out, from a pharmacy in the US, it is usually because the patient uses insurance. For example, if you go to CVS and get a 15 day supply of Percs from Dr Grumpy on your insurance, then tomorrow go to Rite Aid to get Percs from Dr Pissy, the insurance will reject, saying it is too soon to fill. Then you just have to follow up. This is not always done, which perpetuates the problem. Also, insurance companies send reports to doctors about suspicious prescription activity.

If you are a known problem patient to a retail pharmacy, chances are there is a note in your profile to alert staff about your shenanigans. And you know a druggie when you see one. Not that I haven't been wrong, but I prefer to err on the side of caution. It is common for staff just to say its not in stock, thereby avoiding the confrontation altogether. That doesn't really help anyone though.

In Massachusetts every community has an approved return program..contact your local board of health for info. Often there is an annual or biannual program for a day or half day where you can go to dispose of unused medications. Or call the pharmacy that dispensed the meds and ask for instructions.

We can actually leave notes on a parient's profile in the pharmacy if they exhibit suspicious behavior. The problem is if they're a cash patient (which doctor shoppers and seekers normally are). If they're using different chains, none of the pharmacies would have any idea. In the state of Florida, though, we have an online database of narcotic prescription fillers. So if the pharmacist takes the time to check that, they can see what med the patient has gotten filled, on what date, and at what pharmacy. And you can usually tell the seekers from the people who actually need the medication and are using it properly.

Word to the wise drug seeker... If you call me 20 minutes after your "friend" picked up your monthly "scription" of narcotics or ADHD amphetamines complaining that you were shorted 30 pills and you know so because they "weren't in the right sized bottle"... like it's no difficult task to move a label from one sized bottle to another...Fuck You. Do you think I'm stupid? I will have the police review the recorded images of how we double-counted your pills and do a narc-count on our cabinets, upon which I'll have them issue a warrant for your arrest for illegally trying to obtain amounts of a Federally controlled substance, punishable by law. You can take that shit to the fuckin' bank, baby! I'm sick of this cat 'n mouse game we must play every goddamm month. Again, Fuck You, and enjoy your stint in prison. Hopefully, for your sake, you will have figured out how to hide your mustache (i.e. prison pussy) from the real criminals by then. I think you know who you are..

Also in Mass, there is a Prescription Monitoring Program available to each doc through the Department of Public Health. The doctor signs up (it's free, I believe), and then, whenever s/he writes a Schedule II prescription for Ms. Poppy, s/he can check on line and see what other Schedule II drugs Ms. Poppy has received and from whom. It is a big help to docs who might have suspicions about a particular patient - especially a patient he is seeing for the first time. (Yeah, ok. I am giving up on the politically correct s/he, but my heart was in the right place.) The doc does not have to wait for another physician or the pharmacy to notify him of suspicious patients.

I was actually shorted twice in one pharmacy on my Percocet script. The first time, when I got it home and opened it, I thought the bottle looked a little short. I counted, and sure enough, I was down 8 pills. I was also smart enough to realize that once I got home with it, there was nothing I could do about it. The next time, I counted them at the counter with the pharmacist persistently telling me there was no reason to do this. Much to the pharmacist's surprise, I was short again. Seems that one of the techs had developed a system of sneaking a few pills into his pocket between the double count and putting the pills in the bottle. It was a lucrative second job for him and helped him pay his defense attorney.

Have you ever noticed that no patient ever calls ikn a panic to say that they lost their ampicillin script? Tricia

Is it possible that the patient may just be terrified of pain and uses several doctors because no one will give enough?

I've been really struggling to keep up with the few doses a week (4) that my headache specialist gives me for my migraines for fear of rebound. But is the problem really that rebound is increasing or that awareness of rebound is increasing? It seems that it's becoming more in the public knowledge than it was ten years ago.

As i was just discussing with my parents last night, sometimes I get really suicidal not because of depression or such, but because I feel like I can't live with the high degree of pain that I suffer on a constant basis and can't get adequate relief from doctors because they are so worried about either getting me addicted or having rebound that they'd rather let me suffer agony than risk potential rebound.

Vicki, you have a drug problem. As a migraine sufferer for many years, fact is, narcotics cause rebound headaches. That, of course, is if they are true migraines. There are so many better choices for migraines.

Antihistamines enhance the narcotic effect so of course, those made a big difference for you. Seek pain management & lose the narcs.

Why do you people care so much? I'll admit, its funny. Ya caught her. And at that point I see why you don't want to fill it for liability reasons once you know what shes doing. But some people, typically the pharmacists, not the doctors, are such assholes! Opiates are under-prescribed, or at least under distributed (due to douchey pharmacists). Yes there are people who abuse them and cause harm by selling them on street corners, but so many that just take them for personal use. And yes you can argue that some, like her, take too many (I wont get into my argument about that more than I say its her business not anyone elses if shes not causing harm, but I do see - as I said - why youd stop after having knowledge for legal reasons). Most importantly, the joking-condescending tone that Pharmacists and doctors use on blogs and such is so unfair to the people who actually use them for chronic pain, such as myself. Before you yell at me, I dont take them to get high, I dont take more than my doctor prescribes, I've never had any issue/problem or trouble with my situation... I just dont like seeing how they act like NOBODY actually uses them for a real need. I couldnt get out of bed to eat without them. As it is, I barely ever leave the house except to take my dog out in a self-made wheelchair contraption (its actually pretty cool lol). Just my thoughts, anyway, I like your blog. Take care

Hey Anon who was talking about the guys "prison pussy" a) gross, lol. b) I dont think you understand how the legal system works. Yes if they came and made an issue trying to get more saying you defrauded/shorted them you could call the police. They could review the evidence to show that you did not. Which would, rightfully, take any trouble off you. The likelihood of them being arrested for "illegally trying to obtain amounts of a Federally controlled substance" is about zero to none. First, there would have to be a specific statutory law (or case law I suppose) covering the issue, its not the same as them going and buying from an undercover cop, and second the burden of proof would rest on the prosecution which if you were thinking theyd be arrested would be the state. No prosecutor would ever go to a trial with that evidence. Especially when they say, oh, ok sorry I must have miscounted, etc

Vicki has a drug problem because she takes an antihistamine with her pain medication? Thats absurd. How do you know that the narcotics she is prescribed aren't right for her condition? Yeah it can 'enhance' the effect, more just adding to the 'nod' effect if you ask me, but that hardly makes her have a drug problem. Especially when shes talking about how she takes it to help control the itching commonly caused by that medication

This one really made me angry though. People like this make me sick, as a patient with chronic pain who goes to a legitimate pain clinic. All of the seekers, abusers and dealers cause problems for the doctors (government getting involved), pharmacies, and actual patients in need of opiates to be able to function and stay off SSDI.

Too bad we "douchy" pharmacists have this pesky thing when we dispense a controlled substance called corresponding liability, we are just as responsible as the physician. I know I spent 4 years in undergrad and 4 years in pharmacy school to be the drug police, my classmates did to. Hearing every excuse under the sun for why multiple people need narcotics filled early every day is a blast. Wait getting assaulted 8.5 mths pregnant because an ER doc asked me to destroy an opioid Rx for someone who had been to their 5th ER in 3 days was the best. Getting robbed at gunpoint multiple times, isn't that every young professionals dream. Giving multiple people the benefit of the doubt over and over because I want to be empathetic and caring and worry about unecessary suffering, has gotten me burned time and again.

So I have rules, my chronic pain patients follow them with no problem. They have developed a relationship with me, I will talk to their MDs if I have a suggestion and that can be effective. I even have a few special case patients where a fill in pharmacist may hesitate because they don't know the MD and the dose is high, my techs will call me and I will make sure it is taken care of. The only patients who have problems with our rules and the laws are the ones who are usually not taking their meds appropriately, they always want them early, bounce around the er's and primary care docs, so I do my job and I make sure the prescriber knows and usually they don't. Doctors and Pharmacists are not the bad guys here, we are working within the framework the government allows. Yes narcotics help a lot of people, but they are also killing a lot of people too. Do you realize a lot of those OD's and addictions are happening to teenagers. Kids with their whole lives a head of them cut short or severely set back because of drugs they naively think are safer because they came from the family medicine cabinet.

So no we really are not the bad guys, but there are licensing agencies, DEA, state narcotics task forces, public health implications, sociological and psychological considerations, patient safety (robberies, break ins). Etc that must be considered. One last point narcotics are not always the best option for pain, they may seem it while your on them, but physiologically they actually can trick your body into thinking your in more pain then you are. Many people who go off or to a much lower dose find there pain more manageable after an adjusting period.

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